24/7 Emergency Line 0800 5999 009

CLAIM

24hr emergency line 7 days a week
0800 599 009

So we can respond appropriately to your claim/incident, please complete as many fields as possible. Fields marked * are mandatory

Your Details (as instructing principal)

Your Name (required)

Your Position (required)

Your Company (required)

Your Postcode (required)

Your Telephone or Mobile number (required)

Your Email (required)

Property/Incident Address Details

Company (required)

Company Address (required)

Company Postcode (required)

Contact Name (required)

Contact Telephone (required)

Contact Telephone 2

Property Type

Incident Type

Brief Description of Incident(required)

Response

Actions Required

Immediate Start? (if Yes, all fields in this section must be completed)

Authorisation Name

Authorised Person's Position

I am authorised to approve works on behalf of my Organsiation or Insurer Prinicpals in respect of this instruction

Purchase Order Number

Value of works not to exceed £

Insurance Details

Insurance Company Involvement? (If Yes, please complete as many fields in this section as you can.)

Insurer

Claim or Policy No.

Loss Adjuster (if applicable)

Loss Adjuster Reference

Liability Accepted

Adequate Insurance Confirmed

Support Scheme Membership

Please tell us if you qualify for preferential service levels and terms under one of our support schemes:

Membership Number

Crisis Response Member?

Crisis Control Member?

I am an authorised to instruct Humidity Response in respect to this incident/claim

I have read and accept the Humidity Respone's Standard Terms and Conditions

Please check the box below: